Pre-exposure prophylaxis (PrEP) for HIV: effective but controversial

Despite continuing public information campaigns, there were 6095 new diagnoses of HIV in the UK in 2015. 75% of these new infections occurred in men, and men who have sex with men (MSM) were disproportionately affected, accounting for 56% of new infections.

Pre-exposure prophylaxis, or PrEP as it is widely known, provides hope that many of these new infections could be prevented. PrEP usually consists of a combination of tenofovir with emtricitabine (Truvada).

The UK PROUD study in HIV-negative men who had sex with men and who had had anal intercourse without a condom in the past 90 days showed that HIV incidence was reduced by 86% for those on PrEP compared to those in the deferral treatment group. This means that to prevent one new HIV infection, you would have to treat 13 men of a similar population with PrEP for one year. This is likely to be highly cost-effective.

Potential issues are that people on PrEP will engage in riskier behaviour and there is some concern that drug resistance could increase.

There is an ongoing issue around whether the NHS will pay for PrEP. At the moment, most people taking PrEP are obtaining it privately – many in an uncontrolled fashion via the internet.

What do you think? Should PrEP be available to selected groups on the NHS? What concerns would you have? Is it really any different to the introduction of the contraceptive pill in the 1960s? Comment below.

The “game-changing” drug which dramatically reduces the chances of being infected with HIV is to be made available on the NHS in Scotland.
The Scottish Medicines Consortium (SMC) has agreed to approve the treatment, which is known as Prep.
Scientists have found that a daily dose of the drug can protect people at risk of contracting the virus.
It means Scotland will become the first place in the UK to routinely offer Prep to eligible patients.
Campaigners welcomed the SMC’s decision, describing it as a “bold step” which could lead to a reduction in the spread of the virus.
They estimate that up to 1,900 people north of the border could benefit from the drug, which has the brand name Truvada and costs about £450 a month.
Safe sex practices
The anti-retroviral drug is already licensed for use by people diagnosed with HIV in Scotland.
However, the SMC’s decision relates to its use on a preventative basis by people who do not have the virus.
The group said Prep was one aspect of a wider HIV prevention strategy and it should be used in combination with safe sex practices such as using condoms.
SMC chairman Dr Alan MacDonald said: “[Prep] when used together with safer sex practices may help to reduce the spread of HIV, which is an ongoing priority for the Scottish government.”

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